AB0764 Factors associated with remission after gradual decline of TNFi in spondyloarthritis
Authors: S. Abdellaoui, S. Lefkir
Journal: Annals of the Rheumatic Diseases (2022)

Background The natural history of axial spondyloarthritis (axSpA) includes periods of remission interspersed with flares. It is recommended to target remission during the disease management, the 2 most used definitions are ASAS partial remission and inactive disease (ASDAS &lt;1.3 and / or BASDAI score &lt;3.6). The factors associated with the gradual decline of biologics after achieving remission have been little explored. Objectives The objective of this work was to assess the proportion of patients with axSpA treated with TNFi in whom remission was maintained concomitantly with tapering at 3 years of follow-up and to identify the factors associated with this remission. Methods Single-center prospective descriptive study. A total of 44 patients included who attempted to space TNFi injections (etanercept, infliximab, adalimumab) among the 192 patients treated with bDMARDs, all of the patients fulfilled the ASAS criteria for SpA. Data collected: socio-demographic, clinical-biological and imaging data up to 3 years of follow-up. Results At the 3-year visit, a biologic decrease was achieved in 22.9% (86.4% maintenance of remission and 9.1% with relapse). That is a total of 19.8% (38/192) of patients (mean age 34.2 ± 8.1 years; 71% of men with HLAB27 positive 63.2% with low BMI in 68.4%) maintained clinical remission with TNFi tapering at the 3-year visit There was a significant association between ASDAS (p &lt;0.001), BASDAI (p &lt;0.001) and CRP (p = 0.004) per visit and maintenance of remission. Likewise, patients in remission more often presented strictly axial damage without enthesitic or peripheral damage and minimal structural on concomitant radiography (p = 0.03). They reported low smoking and stopping use of NSAIDs. Factors associated with successful 3-year TNFi spacing were a shorter delay between diagnosis and initiation of the biologic (0.9 [0.64-1.3]) and initial presentation of acute illness according to patient examination (2.37 [1.06-5.26]), a lower BASDAI and BASFI (respectively 1.3 [0.84-1.6] and 0, 9 [0.74-1.4]) and a lower NSAID score (0.715 [0.43-0.9]). Conclusion AxSpA patients in remission as defined by ASAS had significantly fewer objective signs of inflammation concomitantly but also over time. It is possible to maintain this remission after gradual decline in the biologics at 3 years in axSpA. Low activity and functional scores, as well as low consumption of NSAIDs are predictive of the success of tapering. Discontinuation treatment is not recommended due to the high risk of relapse. References [1]Won Park J. et al. Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study. Arthritis Research &amp; Therapy (2019) 21:163 [2]A. J. Michielsens C. et al. Dose reduction and withdrawal strategy for TNF-inhibitors in psoriatic arthritis and axial spondyloarthritis: design of a pragmatic open-label, randomised, non-inferiority trial. Trials (2020) 21:90 Disclosure of Interests None declared